How Can Canadian Telcos Create & Implement A

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HOW CAN CANADIAN TELCOS CREATE & IMPLEMENT A HEALTHCARE IoT STRATEGY UTILIZING THEIR EXISTING NETWORK INFRASTRUCTURE TO ADDRESS THE ISSUES IN THE CANADIAN HEALTHCARE SYSTEM

APRJ-699 Applied Project - MBA Sayan Sivanathan Word Count: 15,296 Dr. Andre Haritz

Acknowledgement

I am extremely grateful to all individuals who have helped me to conclude this research study successfully. I have been able to develop my skills on the different approaches related to this dissertation. I would specially want to convey my deep gratitude to my academic coaches

Dr. Andre Haritz and Dr. Angela Workman-Stark, who have guided me whenever I needed any help during this study. Special thanks to Michael J. Martin, Cathy Szabo, Raj Vijan,

Tyson Roffey, Ken Gouveia, Ying Tam, Zeine Teeka, Tim Ing and Michael Widner for the in- depth discussions on Canadian Healthcare and IoT. I am also excessively thankful to my classmates and colleagues for sharing their knowledge on healthcare IoT strategies. Finally,

I would like to thank my wife (Anu), my three boys (Shaye, Bryce & Levi) and my family (my father - Sivanathan, mother - Jeyamaharani, brother- Sanchay, sister- Hamza, father in law-

Ilangainathan and mother in law- Pushparany) who have been a constant source of support for me and have endured my tantrums during the conduct of this study. Thank You. Abstract

During the depression years, the need for public healthcare grew and this led to Tommy

Douglas putting forth his model of public healthcare in Saskatchewan in 1962. It was Tommy

Douglas’ vision that every Canadian, regardless of social or economic status, should have access to public healthcare. Since 1966, Canada’s public healthcare system has gone through significant evolution. Despite government commitment to preserving the healthcare system, there are several gaps and inefficiencies in the healthcare system. Some of the issues include long wait times, the systems are too costly to operate, it is wrought with inefficiencies, the Canadian population is ageing, and there has been an increase in chronic disease and illness. The main purpose of this conceptual paper was to determine whether

Canadian Telcos can leverage their existing network infrastructure with IoT to assist with the problems faced by the Canadian healthcare system. To achieve this goal, the paper undertook a qualitative approach by examining various data from scholarly articles, media articles on healthcare, case studies, healthcare blogs and an examination of current solutions offered by Canada’s “big three” telecom companies (Bell, Rogers and TELUS). The key findings of this paper was that by implementing IoT and 5G (5G is a term that stands for fifth generation, and it is the latest technology in wireless communication network) via various communication companies, the Canadian healthcare system can become more efficient; through new technological advancements and communication between medical professionals and the public.

Table of Contents

1.0 INTRODUCTION ...... 2

2.0 RESEARCH PURPOSE AND RESEARCH QUESTIONS ...... 14

3.0 LITERATURE REVIEW ...... 17

4.0 RESEARCH DESIGN & DATA COLLECTION ...... 44

5.0 ANALYSIS/RESULTS ...... 46

6.0 RECOMMENDATIONS ...... 76

7.0 CONCLUSION ...... 82

APPENDIX ...... 84

REFERENCES:...... 94

1.0 Introduction

1.1 The state and opportunity of the Canadian HealthCare System

Canada’s public healthcare system is part of the Canadian identity; it is cherished and valued by Canadians, as well as newcomers to Canada. Our healthcare system is what makes us unique in comparison to other countries in the world. In centralizing our identity in free and affordable healthcare, Canadian’s have become complacent. Although having affordable healthcare is a phenomenal asset to the nation, it is critical that constant improvements are invested in. With more hospitals planned to be built in the near future, the government of Canada has a big opportunity to invest in new technologies that can be integrated in the infrastructure that will improve the efficiency of the healthcare system. Technologies like machine learning software that detects certain cancers and tumors via imaging and incorporating Internet of

Things (IoT) framework into data collection are two areas that should be addressed first. Machine learning software that detects cancers and tumors are currently being tested and proven for their efficacy as we speak which reduces the risks associated on a government incorporating it into their healthcare system. On the other hand, IoT systems are still in their infancy and still must be heavily invested in to perfect their systematic flow and connectivity of data. The security of data during the holding or transferring of data is a key aspect that must be confirmed before the technology is fully integrated. The Canadian government could easily partner with telco companies and share the burden of investing, research and developing the refined means in which this technology can be implemented into the current healthcare system.

In regards to implementing an IoT framework into the Canada’s telecommunications industry consists of six sectors: local, long distance, internet, wireless, data, and private lines. The two largest sectors combined Internet and wireless, have grown by more than $7.3 billion or 25.9%

2 since 2012, and accounted for more than 63.8% of total telecommunications revenues in 2012 and 72.3% in 2016. Over the same five-year period, wire line voice service revenues have shown steady declines, representing 18.5% of total telecommunications revenues in 2016 compared to

25.6% in 2012. (Pwc.com, 2018).

In 2016, Canadian telecommunications revenues reached $48.7 billion, with the vast majority

(92%) derived from retail services and the balance (8%) from the wholesale sector. Service providers supplied retail services to over 14 million households, 1 million businesses, and, through the wholesale market, 800 other telecommunications entities. Service providers continued to increase investments in their infrastructure, with capital expenditures reaching

$11.6 billion in 2016, an 11.3% increase over 2015 levels. Canadians from coast to coast are proud of our healthcare system and it’s what separates us from the US (Seekingalpha, 2016).

Since the implementation of the Canadian Medical Insurance Act in 1968, Canada has had a fully functioning public healthcare system. The current model covers a large number of healthcare services. Despite the comprehensiveness and functionality of the Canadian

HealthCare system, it is not without its flaws. Canada’s healthcare system faces major challenges and is now falling behind the healthcare systems of other commonwealth countries.

1.2 Pride Canadians have in their healthcare system

Canadians from coast to coast have a tremendous amount of pride in our healthcare system.

Canada’s earliest form of public healthcare began at the end of World War 1 (WWI), where the

Canadian government offered free healthcare to Canada’s WWI veterans. During the depression years, the need for a public healthcare grew and this led to Tommy Douglas putting forth his

3 model of public healthcare in Saskatchewan in 1962. It was Tommy Douglas’s vision that every

Canadian regardless of social or economic status should have access to public healthcare.

Tommy Douglas’s vision was put into action by the Lester Pearson government in 1966 through the Medical Care Act or Medicare. Since 1966, the Medical Care Act has gone through significant changes, however the main principles of Act (a public healthcare system across

Canada) remains in place.

1.3 Overview of the Problems in Canadian Healthcare

Since 1966, Canada’s public healthcare system has gone through significant evolution. Despite government commitment to preserving the healthcare system, there are several gaps and inefficiencies in the healthcare system. Some of the issues include long wait times, the system too costly to operate, it is wrought with inefficiencies, the Canadian population is ageing and there has been an increase chronic diseases and illness. If solutions are not found to these problems, the Canadian healthcare system will no longer be the pride and joy of Canadians.

Successive governments have worked towards finding solutions towards the problems of

Canadian healthcare. However, much of the solutions are short-term and the problems stated above, will re-emerge with time. The Canadian government has yet to find a long-term solution to the problems stated above.

The Canadian healthcare system takes care of all its citizens, where all have been given access to quality healthcare. One of the problems with the Canadian healthcare system is the factor of long wait times (Picard, 2017). Unless, one has a chronic illness or conditions, they could wait

4 to get healthcare services in hospitals for as long as weeks, months or even over a year. Another issue is that of an ageing population. This problem comes coupled with another problem which is increased cases of chronic illness (Blake, 2015). The Canadian healthcare system was created in order to deal with chronic illnesses and injuries. However, nowadays, there are more cases of chronic illness, which the system is not sufficiently equipped to treat or manage. Also, there is an increased population of the elderly which means higher costs for the government and

Canada in general in order to support their healthcare treatment of this increasing population

(Picard, 2017). This is proving to be expensive for both the governments and other Canadians.

1.4 Overview of Internet of Things (IoT) in Canada

IoT applications are increasingly being adopted in the healthcare system and have shown tremendous capacity to improve med-tech strategy. In Canada, IoT has been embedded in some healthcare related equipment and is utilized by either being implanted or attached to patients, to collect important information for easy and appropriate monitoring of patients (Geissbuhler,

Demongeot, Mokhtari, Abdulrazak, &Aloulou, 2015). However, IoT remains underutilized in

Canada and Canadian Telcos and IT companies have an opportunity to invest in creating and implementing a better and more efficient IoT to enhance the Canadian healthcare system (Zhou

& Salvendy, 2017). For IoT to be expanded in Canada there are various challenges that need to be overcome and can be understood through ways such as situational analysis, environment analysis as well as benchmarking in order to understand what works best for Canada

(Thuemmler & Bai, 2017).

Over the past decade, there have been considerable efforts in creating and implementing IoT in

Canada. However, there are still numerous challenges that need to be addressed to ensure that the IoT strategy developed is capable of addressing the challenges within the Canadian healthcare system. The challenges revolve around the privacy, information security, standardization of communication as well as the ways to educate end users to ensure they are all conversant with the implementation and utilization of IoT (Zhou & Salvendy, 2017). However, these IoT challenges are universal and not unique to Canada and can thus be addressed through appropriate analysis of the Canadian healthcare system to understand what needs to be done for successful creation and implementation of the IoT strategy. The analysis should entail understanding the current network infrastructure and how the IoT can be successfully integrated into the system. In this regard, tools such as PESTLE, Porters 5 forces, environmental analysis, benchmarking (industry best practices), BCG matrix, value chain analysis, triple bottom line and other theories will help reveal crucial information regarding the Canadian healthcare system and how the IoT can be created and implemented to best utilize the existing system.

1.5 New Entrants

With the growing issues of an aging population, the increased cost of healthcare facilities and lack of modern healthcare facilities are attracting many new companies into the health industry of Canada. Moreover, with the increase in chronic diseases, new entrants are going to disrupt the current healthcare market. Market research conducted by Price Water House Coopers has shown that there is a potential of US$9.59 trillion in available growth. (Pwc.com, 2018). Along with the discovery of new medicines and life-saving drugs, new entrants have been coming into

6 sectors such as technical, technology and telecom industries. However, the wellness and fitness industry is booming and it accounts for approximately US$1.49 trillion. (Pwc.com, 2018).

Figure 1: Impact of new entrants in healthcare markets (Source: Pwc.com, 2018)

Companies such as Sanofi Canada, SK Telecom, and Telefonica are coming and investing in the healthcare sector of Canada. Sanofi Canada is one of the important pharmaceutical companies that has collaborated with TELUS and have built a web-based platform that will help patients in self-monitoring their health status (Baker and Axler, 2015, p.1). Moreover, with the improvement in technologies in healthcare facilities, patients are reaping the benefits in most developed countries. With introduction of the mobile health checkup platform, it has become possible for all the patients to monitor their health status regularly. Previously, the Automatic

Teller Machines were limited to which restricted the smooth flow of cash that forced the patient party to face a lot of complications. According to Bashir and Ungar (2015, p.527), the improvement in the information and communication technology have helped the development of

7 the sectors such as banking, traveling, retail marketing, healthcare services and the pharma industries.

Figure 2: Interconnection between improved technologies and internet communication (Source: Pwc.com, 2018)

The wellness and fitness, primary care and acute care have improved significantly with the development of the internet and communication. Research facilities and tertiary care centers have been improving. Internet and new communication technologies have assisted in upgrading prescription drugs which are helping to cure complex health issues. Furthermore, better research facilities aided by technology have introduced and improved new treatments such as laser treatment, angioplasty and installation pace makers. These new upgrades in technology are helping to cure many acute conditions. These improvements are helping man-kind in knowing the actual causes of the diseases and ways to cure them.

Please see APPENDIX 1: Improvement of IoT in healthcare industries

1.6 Introduction to the Canadian Telcos

In terms of provider choice, Canadians are served by three large national telcos, collectively accounting for 89% of wireless service subscribers. They are known as the “Big Three” - Bell

Canada Enterprises (BCE), Rogers Communication Inc (RCI), and TELUS Corporation. BCE is the most widely known telco due to its wide coverage, an ecosystem that provides customer support, and a large network infrastructure that overs 80% of Canada. Rogers is known for its media & marketing strategy, as well as its focus in innovation and network leadership. TELUS

Corporation is the fastest growing telco in Canada and this is due to its innovation in network management and delivery to consumers. The company has seen high consumption from its consumers especially in wireless and wired line connections (IoT Ignite, 2017). TELUS is also one of the first telcos in Canada to be involved in the Healthcare space.

Figure 3 Telecommunication revenue (Source: Blake, 2015)

Figure 4: Key success factors (Source: Seekingalpha, 2016)

Table 1: Wireless service subscriber market share by province and territory (2016) (%)

Wireless service subscriber market share by province and territory (2016) (%) Province/territory Bell Group TELUS Rogers Other British Columbia 20 41 38 0 Alberta 25 52 23 0 Saskatchewan 17 13 5 64 Manitoba 9 7 38 47 Ontario 30 21 47 2 Quebec 30 27 28 15 New Brunswick 55 26 19 0 Nova Scotia 53 34 13 0 Prince Edward Island 56 31 13 0 Newfoundland and Labrador 69 28 2 1 The North 86 10 0 3 Source: (CRTC data collection)

Canada’s telcos have different shares of the provincial/territorial wireless market. This table displays the market share owned by the major Wireless Service Providers (WSP), excluding

Freedom Mobile and Eastlink/Bragg, in Canada’s provinces and territories. Other service providers include (but are not limited to) SaskTel, MTS, and Videotron. The three major WSPs have the largest market share across all provinces and territories except Saskatchewan and

Manitoba. The North includes Yukon, the Northwest Territories, and Nunavut. As of the year

2016, BCE was reported to have a market capitalization of $48.5B with dividends as high as

4.52%. BCE’s annual revenue is $22B per year. Rogers has a market capitalization of $24.8B with dividends as high as 3% per share. (www.forbes.com, 2018). Rogers has annual revenues of in the amount $14.4B. TELUS has a market capitalization of $27.07B and annual revenues of

$12.6B per year. In terms of current wireless market share in Canada, Bell has 28% of the wireless market, Rogers has 34% of the wireless market and TELUS has 29% of wireless market. Based on the graph above, Canada has approximately 30 million wireless subscribers, and approximately 90 percent of market is still controlled by Rogers, Bell and TELUS. (Hardy,

2016)

2.0 Research Purpose and Research Questions

The focus of this applied project is an in-depth study of how Canadian Telecommunication companies (Telcos) can leverage their existing network infrastructure with IoT to address the problems in the Canadian Healthcare system. There is a tremendous opportunity for Canada’s telcos to take a lead in assisting the Canadian government to solve the problems of Canadian

Healthcare. The results of this study will enhance the existing knowledge base on how other smaller telecoms can also develop IoT solutions to address the problems in the Canadian

Healthcare system.

A qualitative design was used for this applied project in order to reveal the complex and multi- layered nature of technical development, while also allowing for identification of some of the problems related to this new technological advancement in Healthcare ( Leedy & Ormrod,

2016). The main component of the research for this applied project was a review of existing literature on healthcare problems and technological development in order to identify trends in essential components and best practices.

Information from the research and literature on leadership development approaches and frameworks were accessed by searching the Athabasca University library database, as well as secondary sources by using search terms related to essential components of healthcare and technology. This resulted in a selection of over 75 research components on current healthcare issues in Canada, current technological developments in the healthcare field, the structure and

14 revenue of Canada’s’ telecom companies and some of the problems the Canadian telecom companies may face in implementing a healthcare strategy.

Information on current issues and problems of the Canadian healthcare system was accessed through a series of articles written by a variety of commentators/authors, who have commented on the problems of the Canadian healthcare system. Current development approaches in healthcare organizations were accessed via the Canadian Institute for Health

Information, as well as industry reports from Accenture & McKinsey. Additional information on specific organizational approaches to technological advancements were accessed through various websites that provided current data on some of the technological development in the

Canadian healthcare system. Furthermore, the current position of the Canadian Telecom companies were obtained from their individual websites.

The macro environment of the Canadian healthcare system was then assessed using the

PESTLE analysis to identify forces impacting IoT and issues in the Canadian healthcare system. The environment was also analyzed using the SWOT approach, which included opportunities and threats identified in the PESTLE, as well as internal strengths and weaknesses in the internal environment, informed by reviewing existing secondary data. This non-public, secondary data was pre-existing in the organization in a form that makes it impossible to identify individuals or their responses. As such, neither an Athabasca University research ethics application, nor an Applied Project Corporate Confidentiality Permission

Agreement, were required (Athabasca University, 2015).

The results of the SWOT analysis of the Canadian telcos were used to compare and contrast with the themes identified in the literature review, which resulted in the identification of gaps in the IoT within each telecom organization. Recommendations for creating a comprehensive healthcare IoT strategy was developed by considering the limited financial and human resources of each Canadian telecom company; in conjunction with the components of conceptual analysis that emerged throughout this applied project.

3.0 Literature Review

3.1 HealthCare Problems in Canada

Figure 5: Healthcare system performance (Source: Seekingalpha, 2016)

Most Canadians have timely access to emergency and urgent healthcare issues such as

Treatment for Heart Attacks, Cancer Care and strokes. However, many Canadians face long wait times in order to get access to specialists for mid-level healthcare issues such as hip/knee

17 replacements, cataract surgery, shoulder/ankle surgery or other mid-level healthcare issues.

Because of long wait times, Canada now ranks behind other Commonwealth nations in providing quality healthcare to its citizens.

Management of chronic diseases is one of the main problems in Canadian Healthcare. Simpson states that many Canadians face chronic diseases such as diabetes, dementia, heart failure, chronic lung diseases and arthritis. Furthermore, for these types of chronic conditions – hospitals are still needed. However, as the Canadian population grows and ages; this will put a greater strain on our already over burden hospitals. Therefore, Simpson argues that we need to “de-hospitalize” and move to more community based solutions. Simpson states that Canada has more seniors than Children in a 2014 published report. Aging Population is going to increase costs per person for the Canadian healthcare system. Due to advancement in healthcare –

Canadians are living longer but as Simpson argues this will put more strain financially on the

Canadian healthcare system.

Hospitals are still needed, to be sure. But increasingly, the population needs community-based solutions. We need to “de-hospitalize” the system to some degree so that we can offer care to

Canadians in homes or community venues. Expensive hospitals are no place for seniors with chronic diseases (Simpson 2017).

Another challenge in the Canadian Healthcare is the lack of services covered by the provincial insurance plan – this plan only applies to physicians and hospital services. Other services like dental, out-of-hospital pharmaceuticals, long-term care, physiotherapy and homecare services are usually provided by a mixture of private and public insurance and out-of-pocket payments,

18 which is beyond the reach of many low-income Canadians. Hence, with the lack of services provided by the provincial insurance – the health of the Canadian public is impacted – which means more people will be overcrowding the hospitals.

Canada being one of the most developed nations of the world depicts significant amount of concern towards healthcare facilities. It has been observed that healthcare in Canada has been made cost free. The funding for healthcare services in Canada is generated for governmental and federal sources. The major lag in the healthcare system of Canada can be identified as the lack of effective managerial attributes. Managerial attributes can be accessed as one of the primary aspects towards utilizing maximum potential of any system (Gope and Hwang, 2016, p.1368). The lack of healthcare management in Canada has caused a major imbalance of healthcare services within the common population. The management of Canadian healthcare significantly lacks proper assessment of health care needs of the nation. This lack of managerial skills can be identified as the primary aspect influencing the degradation of healthcare services of Canada.

Figure 6: Health care issues in Canada

(Source: Gope and Hwang, 2016, p.1368)

Lastly in Simpson’s article, he states that Aging Population and Increasing Costs will be the major challenge for the Canadian healthcare system. Simpson states that Canada’s health-care system is subject to numerous pressures and all, successive federal governments have been effectively reducing their cash contributions since the late 1970s. Increasing costs on medical per person is rising. In 2017 the average medical spend per Canadian was $6604, almost $200 more per person than in 2016 ($6,419) and the Canadian government spent over $240B in

Healthcare.

3.2 IoT ( Internet of Things)

IoT is an acronym that means Internet of Things. The Internet of Things is described as the next step in the evolution of the internet and it is the interconnection of other non-computer devices onto a network so that these devices and components can also communicate and work together

(Dohler, 2015). The idea of the Internet of Things has been revolutionary in that it presents the opportunity to create a fully digitized and automated world where people and electronics can interact the same way they do with computers. A good example would be to imagine a network where components such as refrigerators, air conditioners, or even coffee makers would be accessible, usable, and programmable just in the same way that we can give commands to computers. The IoT aims at automating all electronic devices and use them for their intended purpose and much more such as geo location and mapping.

Figure 7: IoT (Dohler, 2015) IoT or internet of things can be evaluated as a primary consideration for modern day technical world. IoT is the basic of modern day data transfer and networking. IoT can be identified as an interconnected network of electrical devices which enables transfer of data within a network without any human interference. In this modern world of globalization and modernization it is substantial to adapt to IoT related solution (Thota et al. 2018, p.141). In accordance to the interconnected attribute of IoT data accountability and accessibility has been considerably influenced. It has been evaluated that almost 30% of the global business is dependent upon the use of IoT. With the help of IoT networking and electronic related studies have been facilitated tow a large extent. IoT considers cloud computing for storing and transferring of data. Cloud computing considers an imaginary digital space and facilitates the user to use the imaginary data location for storage and transfer of things.

Figure 8: Working of IoT (Source: Thota et al. 2018, p.141)

3.3 Healthcare and IoT

In recent years, there has been a buzz about the Internet of Medical things (IoMT), which is IoT that is concerned with medical devices and equipment (Thakur, Hsu, & Fontenot, 2012). This technology is said to be revolutionary where it will improve healthcare in ways we cannot imagine. the IoT will include components such as RFID, NFC and other sensors and actuators, which can be used in healthcare to monitor and improve the health of a person. For example,

IoT can include sensors which can be in or around the body of a patient, and these devices will allow the medical practitioners to have live data on the state of the patient and this will allow for easy and quick treatment, easy monitoring, and a better understanding of these conditions

(Thakur, Hsu, & Fontenot, 2012). This will especially assist in dealing with the aspect of increased cost of healthcare as a result of an ageing population.

As discussed above IoT can be understood as the interlink age of data transfer over a network without human intervention. In this modern world adapting to technical advancement is necessary for gaining the required amount of efficiency aspired by the modern population. In the last decade there has been a substantial effort towards up gradation of healthcare services with the introduction of IoT (Wu et al. 2013, p.11413). IoT can help towards increasing the efficiency of the healthcare services considerably. Booking of appointments, online medical consultants and payment for different medical services can be identified as significant prospects for linking

IoT with healthcare. In this competitive era time is one of the most crucial factors which can be accounted with the help of IoT. Availability of online medical consultants can facilitate considerably towards reduction of waiting time for visiting doctors for general medical issues.

Figure 9: Use of IoT in healthcare (Source: Wu et al. 2013, p.11413)

3.4 Challenge for Telcos in Implementing the IoT in Healthcare

One of the biggest concerns for telcos is when it comes to implementing IoT in healthcare is the aspect of data security and data comprehensiveness. Data security is a problem for IoT solutions and services, where a lot of data can be collected and this presents risks where they must ensure the data is safe, and inaccessible by people with no authorization in order to preserve confidentiality (IoT Ignite, 2017). Also, data may be collected but it might not be meaningful if there is no context to this data such as metadata for search and compile functionalities. As a result, there will be a need to compile all existing healthcare data on medical practitioners and patients, so as to allow for a more widespread coverage and seamless monitoring of patients using IoT.

Canadian telcos or telecommunication companies face considerable amount of difficulty towards managing a sustainable IoT infrastructure within the nation. The primary setback for the nation is the outdated technical infrastructure of the country. The speed required for implementing IoT is not attainable with the present technical architecture of the country. Over the years there has been considerably lowered amount of effort from the governmental bodies of the nation towards improving the technical architecture (Discoveredintelligence.ca, 2018). The present regulation in Canada with regards to technical developments is outdated and lacks considerable effort from the government towards improving the present situation. Another significant issue is the concern of data security realized by computing experts all over the globe. It has been observed that things connected to the IoT network are static and poses serious threat towards leakage of data.

3.5 The Canadian Healthcare System and Global Economic Impact of IoT Healthcare

Strategies

Management of Healthcare throughout the world is very expensive and Canada is no different from its counterparts. The present economic expenditure of the Canadian government for healthcare is over 30% of the nation’s GDP (Patil & Seshadri, 2014). This considerable amount of expenditure can be significantly reduced with the integration of IoT. Research shows that healthcare facilities which have a decreased amount of human intervention accumulated almost a 40% savings in the amount of financial resources used by the healthcare facility (Turner, 2010).

With the integration of IoT, there is increased efficiency as the system is able to maintain a high level of connectivity, while transferring data over a secured network. It is vital that developed countries like Canada maintain the state of the nation and improve upon current conditions. This is due to a “widespread public dissatisfaction with some aspects of Canadian HealthCare - waitlists for some medical services, inadequate out-of-hospital drug coverage, and difficulties in accessing primary care-” that demands improvement (Kenny and Chafe, 2007, p. 25). Richard

Cruess, professor of Orthopedic Surgery and retired Dean of the Faculty of Medicine at McGill

University, conducted a study on the finances of the Canadian HealthCare System, with other medical professionals and philosophers. This study stated that “once comparisons included other industrialized countries. . . analysts discovered that Canada appear[s] to be spending the second largest proportion of GDP for medical care, which [gives] it the distinction of being the most expensive publicly-funded system in the world,” (Saul, Cruess, Rae, Kenny, and Deber,

1999, 73). Cruess concludes his investigation by stating that, “Canada is spending ‘enough’ for healthcare if only it could be better managed.” This can be achieved via the integration of IoT

25 technologies by implementing technological devices and software into the already existing healthcare infrastructure and educating professionals on the system. This will improve the efficiency and security of data and processes that take place in the system.

Figure 10: Economic impact of IoT healthcare strategies (Source: Dimitrov, 2016)

IoT solutions are slowly being researched and integrated into Canada, as mega corporations aim to continue to roll out large scale projects (Wireless Kiosks) like the one Bell Canada is doing in Kingston, Ontario. In S. America, Europe, Asia, Australia, and the USA telecommunication companies have been at the forefront of organizing operations. The first four months of 2018 show that there is robust patient demand. The emergence of services and products significantly impacted the positive sentiment, along with the growth of revenue following suit (Dimitrov, 2016).

In Australia, the healthcare industry consensus is forecasting growth of 5% before 2022. If the intended targets are met, it could push global tech sector growth into the 20%-plus range, all before 2031. Figure 11, below, measures the effect of IoT on health costs and revenue growth from 2016-2031. Figure 11 shows that the health-specific inflation is projected to top, in comparison to demographics and the general rise in 2031, accounting for approximately

$325,000 million of the market.

If IoT solutions are integrated into the Canadian HealthCare System, wait times and expenses from missed appointments will decrease dramatically. As technologies that leverage IoT are rolled out, not only will expenses drop in the average physician’s practice; but also the liability costs with regards to losing patients’ data due to a security breach. As today’s systems are old and insecure, data can easily accessed by a third party who can collect and sell that sensitive data on the black market. For example, Benedikt Fischer, professor of psychiatry, medical science, criminology, and sociology at the University of Toronto, among others, conducted a study on prescription drug use in Canada. Fischer states that there is a “prescription drug abuse and [a] diversion of psychotropic prescription drugs into the illicit drug market.” He continues to claims that “Canada ranks within the top 10% of countries in the use of benzodiazepines, opioid prescriptions and stimulants” which are highly addictive painkillers. Thus, there is a need to alter or upgrade the current healthcare system to prevent these addictive drugs from entering the black market. With the implementation of IoT solutions, security breaches, with third parties searching for information on drugs and other substances, will be relatively non-existent. If in the event there are a few, all data held by the database will not be loss.

Figure 11: The effect of IoT on Health Costs and Revenue Growth (Source: Dimitrov, 2016)

Comparing public and private telecommunication companies (TELCOS) in S. America, Europe,

Asia, Australia, and the USA, there is undoubtedly an opportunity for the healthcare sector to be the leading industry and have a positive contribution to the economy (Turner, 2010). The data from the recently conducted research showed that the public telcos are experiencing a tremendous rise in their profits as per the data from 2004 to 2014 as compared to the private companies. Nevertheless, both are contributing to the increase in the economy, softening the appetite for healthcare projects across the globe. As IoT solutions are integrated into the

Canadian HealthCare System, the system will become more efficient and cost less money. This will have a direct impact on the spending ability at the provincial and federal level. As IoT solutions are used more in healthcare, the expense of missed appointments and wait times will be reduced. This will allow more patients to be seen at both hospitals and clinics and less expenses taken by independent clinics.

Figure 12: Profitable Statistics for TELCOS (Source: Turner, 2010)

The figure above is a graph of companies’ operational years as compared to healthcare profits

($ billions) showing the profitable statistics for these telcos. Of the telcos in the North America and Europe, the healthcare strategy in the United States provides a high standard of care for its people.

Figure 13: Financial Statements Summary of the TELCOS in the US

(Source: Turner, 2010)

The figure above illustrates shows the financial statements summary of the telcos in the US, by showing how the healthcare strategy used is anticipated to bring profits in the next five years. In

2018, the healthcare strategy has enabled telcos to earn $1.5 million in profits, and in 2022, the gains are projected to rise $2 million (Turner, 2010). The growth rate is anticipated to increase by 7% to adjust the health spending per capita, while heightening its ability to attract overseas healthcare talent to work and live in the country, thus increasing the revenue.

The technological solutions used for healthcare in the US are diverse. The companies have already become a data hub, with their ability to develop a variety of data-based industry offerings and consumer services. To ensure adequate care services, the companies have created a controlled data marketplace to store the patient’s data and retrieve information when necessary

(Patil& Seshadri, 2014). This notion has enabled the companies to have the power to enhance care delivery and maximize their profits. The healthcare system’s goal has been put together in an entire ecosystem built on data services to improve active monitoring of patients.

It is evident that the ability to develop a variety of data-based industry offerings and consumer services is beneficial to healthcare services and systems around the world (Patil& Seshadri,

2014). As the figure below indicates, amongst a sample of patients from one of the healthcare services, a number of them have acknowledged the quality of care given, with 76% satisfied with the use of ecosystem built on data services, in comparison with 57% for patients getting medical services using traditional channels. 15% of the company is using these services from start to finish, but 41% starts on an e-care platform and then use regular channels to offer other services.

An external company that integrated an e-care effort saw an immense rise in the quality of care, a 40% reduction of care costs and rise in satisfaction of customers.

Figure 14: Quality of Consumer Services Data-based Industry

(Source: Patil & Seshadri, 2014)

A recent report by Canadian Institute for Health Information showed a rise of in the total costs spent on healthcare in Canada in 2018. Based on health-specific inflation trends from 2011-

2018, health care costs are anticipated to increase at a more reasonable pace of around 2.9% per year (Derlet & Richards, 2000). Consequently, healthcare costs have risen from 40.1% in

2016 to 40.4% in 2018, and will continue to rise, as the figure below reflects. Under the scenario below, there is increased risk of crowding out other programs to employ other fiscal adjustments.

Figure 15: Current and Future HealthCare Costs

(Source: Derlet & Richards, 2000)

3.6 Increase of Canadians’ Life Expectancy and its Impact on the Healthcare System

The population trends in Canada continue to shape country. As a result, the baby boomers, those born between 1946 and 1965, are in their advanced ages. Their fertility rate is now below the replacement level because of their increased life expectancy in male and female sexes. The age pyramid below shows a comparison of age-sex structure on years 1997 to 2017. In the pyramid, it can be observed that baby boomers were in their 30s to early 50s in 1997 (Needham et.al, 2005). And so, the number of people aged 51 years and above was higher in 2017 than in

1997. However, the number of youth, 0-19, and adults in their late 30s and early 40s, has also shown a consistent increase.

Figure 16: Comparison of Age-sex Structure on Years 1997 to 2017

(Source: Needham et.al, 2005)

There is an increased life expectancy in both sexes because of the aging baby boomers. Due to this, the costs of healthcare are projected to rise as funds will be concentrated on human services and a growing share of national resources as elders are expected to use more resources than they have in the past. Healthcare costs will increase at an annual average rate of 6% from 2018-2020, leaving behind the expected economic growth (Needham et.al, 2005).

Currently, Canada’s healthcare tab is around $3.5 trillion, thus; it will increase to approximately

$4.6 trillion in 2020. This accounts for almost a sixth of the economy, which will put pressure on other priorities like infrastructure.

The spending on healthcare this year, in Canada, is expected to be almost $240 billion, and is expected to increase by 4% next year. $240 billion implies $6,509 for every Canadian; $185 more than it was last year. The Canadian Institute for Health Information states that these estimated values are for non-profit organizations. These healthcare estimates represent 11% of the gross domestic product (GDP) of Canada in 2018 (Woolhandler et.al, 2003).

Additionally, there has a growth in drug spending. In 2013, the Federal Government spent $1,012 for every Canadian on medications. In 2017 this spending increased to $1,415; an increase of

7.4%. This spending was a greater spending than most European countries, with the exception of Switzerland. In comparison with other European Union countries, Canada spent $709 more for every Canadian. The figure below shows the proportion of Canadian population 65 years and over. The costs are projected up to 2031, with the healthcare costs expected to rise by 9.3%

(Woolhandler et.al, 2003). This means that the costs will have to be covered by other programs; rather than Federal Government and social security funds.

Figure 17: Proportion of Canadian Population 65 Years and Over

(Source: Woolhandler et.al, 2003)

3.7 The Rising Cost of Mental Illness Treatment in Canada

Mostly, the health issues in Canada include schizophrenia, anxiety disorders, and depression.

As benzodiazepines and opioids treat these disorders along with other mood disorders and insomnia, it is no surprise that there is a large trend of substance abuse in Canada (Reinsfield and Webster 2013). Figure 16 shows the history of Canadian mental illness in the 1900s. The

35 chart shows increased in admitted people with mental illness into a mental health institution, between the years 1932-1946 (Fischer and Stogdill 1952). The chart predicted an increased number of Canadians admitted. These trends are applicable to mental health in today’s society.

Figure 18: Mental Illness Admissions (Source: Fischer and Stogdill 1952)

Schizophrenia, anxiety disorders, depression, and substance abuse are mental illness in

Canada that generates $51 billion every year. On average, a patient with mental illness spends over 29% more than the costs of other patients. This data as organized by IoT-based healthcare solutions can be profitable and more efficient to the government.

3.8 The Canadian Healthcare System and Wait Times

The readiness to deliver quality care services is always a challenge in the healthcare settings.

As the figure below illustrates the distribution of individualized wait times, the recently conducted survey shows that those who died had short, customized wait times. The mean individualized wait times for those who died were statistically lower, 33.4 days, than those who survived, 38.4 days (Derlet& Richards, 2000).

Figure 19: Distribution of Individualized Wait Times

(Source: Derlet & Richards, 2000)

3.9 Preventative Care and Insurance Companies

Using IoT can save a healthcare facility cost not only in the short run, but also in the long run by providing preventive care, remote biometric care services, and information sharing. Preventive care consists of; reminding outpatients on the correct time to take their prescriptions and

37 reminding them to engage in physical rehabilitation exercises (Dimitrov, 2016). These are solutions that many patients do not comply with them, causing 20-30% of lifetime treatments, and 50% of long-term care, which are usually funded by the government. The lack of compliance causes a patient to seek healthcare more often, and this increases costs, taxing the system.

The impact of IoT on the economy is expected to reach $11 trillion by 2022. The signs of this increasing shift can be seen in several industries. For a case in point, in the retail sector, brick- and-motor stores that use beacons to link physical goods to other computing systems accounted to $44 billion in 2016. Therefore, like any other industry, IoT will be a game changer in the insurance companies (Shi et.al, 2016). Given the complexity of insurance companies, new business and contract model can emerge in care settings, which can offer enormous opportunities to deliver quality care services and outweigh threats that increase care costs.

3.10 TELUS’ Role in the Canada Healthcare System

TELUS is one of the established telecom organizations of Canada. The organization has influenced the technical architecture of the nation. The organization has taken an initiative towards improving healthcare facilities in Canada (Telus.com, 2018). It’s primary vision is to create an interconnected connectivity between different aspects of healthcare and to ensure a sustainable information sharing architecture with accordance to healthcare information in the nation. Canada lacks significant amount of networking attribute towards creating a sustainable healthcare service in Canada. As discussed on page 27, professor of orthopedic surgery at

McGill University, Richard Cruess, wrote that the Canadian healthcare system could be better

38 managed. Furthermore, studies have shown that “interconnected networks is found to determine the structure of comparative advantage. That countries with interconnected networks have a comparative advantage of that good [or service] that business services provide via networks.

Producers of that good [or service] benefit from the efficient transmission of business services,”

(Kikuchi, 2003, p. 155). This could be applied to the Canadian healthcare system. Thus, TELUS’ pursuit for interconnectivity and technological advances could benefit the Canadian healthcare system.

TELUS has significantly influenced the healthcare situation in Canada. With accordance to the introduction of IoT in healthcare, the organization has created an integral healthcare facility throughout the nation. The initiatives made by the organization have significantly reduced the average wait age time for the patients obtaining doctors’ appointments in Canada. It has been analyzed that with accordance to the introduction of an interconnected network for healthcare medical consulting have been facilitated to a large extent. There has been a decrease of 12% over the weight age time required for booking an appointment with doctors in Canada

(Telus.com, 2018). This increased amount of information and decreased weight time have facilitated IoT healthcare services in a positive manner.

3.11 What is 5G?

5G is a term that stands for fifth generation, and it is the latest technology in wireless communication network. This technology is an improvement over 4G where it has retained 4G bandwidth and antennae configuration but has increased connection speeds from 1 gigabit per second (Gbps) to 10Gbps on wireless signals. This technology is especially welcome because it will increase bandwidth coverage by 1000 times, less power consumption on mobile devices, and 99.999% perception coverage. There are currently only 6 countries worldwide that have installed the infrastructure for use. The most impressive aspect of 5G is how much data it will be able to handle per second and this will be instrumental in the establishment of new technologies such as IoT, VR, Cloud-based services, and AR.

Telecommunication companies have divided the digital networking space in to subsequent categories. Based on the operating frequency of the range these layers are used for different communication purposes. 5G or fifth generation wireless networking can be identified as the latest advancement in the wireless communication field (Moosavi et al. 2015, p.452). Depending upon the density of users over a particular network band the speed of data transfer can be influenced considerably. 5G can be understood as an extension to 4G technology and considers

LTE (Long Term Evolution) frequency range. The operating frequency of the spectrum has been observed to be 600 MHz (MegaHertZ) to 6 GHz (GigaHertZ) with the introduction of 5G spectrum data transfer rate can be achieved to almost 20 GB per second. With the introduction of 5G technology, the telecommunication industry has been facilitated to a large extent. 5G network

40 considers centralized radio access network over distributed radio access networks which ensures a higher degree of cellular performance.

3.12 5G Networking in Health Sector

5G networks delivery of test results quicker and more efficient than the existing network infrastructure. Detection of different health issues sitting at home is not at all possible for all the individuals of Canada as people are not permitted to access a digital platform of healthcare services (Whiteside, 2015, p.45). Moreover, implementation of the internet in the operation theatre will help medical professionals consult while performing complex operations. Improving system management, and implementing more technological advancements, will relieve stress from healthcare professionals (d'Haenens, 2015, p. 224).

System management and technological advancements help with rehabilitative care and chronic illness dispensary care. The system can become more efficient if it incorporates robotics. Some developed countries are currently using robotics to reduce human error. The introduction of system thinking, or artificial intelligence, is one of the innovative technologies that have been replacing workers in the health sector. Most aspects of imaging and surgery are assisted with high-level robots and software and have posed top quality results.

However, there are lots of barriers in getting access to these advanced technologies (Liddy et al. 2016, p.125). Obstacles include; high operation cost of physical and digital infrastructures;

41 and lack of technologically advanced workers. Among these problems, Human resource and the financial issues are the biggest challenges that the sector is facing (Hepburn et al. 2015, p.559).

Figure 20: Prospect of telecom partners (5G) (Source: Moosavi et al. 2015, p.452)

Figure: 21: Telecom operator revenue potential with 5G (Source: IoT Ignite, 2017)

4.0 Research Design & Data Collection

The focus of this applied project is an in-depth study of how Canadian Telecommunication companies can leverage their existing network infrastructure with IoT to address the problems in the Canadian Healthcare system. There is a tremendous opportunity for Canada’s telcos to take a lead in assisting the Canadian government to solve the problems of Canadian

Healthcare. The results of this study will enhance the existing knowledge base on how other smaller telecom can also develop IoT solutions to address the problems in the Canadian

Healthcare system.

Information from the research and literature on leadership development approaches and frameworks was accessed by searching the Athabasca University library database, as well as secondary sources by using search terms related to essential components of healthcare and technology. This resulted in a selection of over 75 research components on current healthcare issues in Canada, current technological developments in the healthcare field, the structure and revenue of Canada’s’ telecom companies and some of the problems the Canadian telecom companies may face in implementing a healthcare strategy.

Canadian healthcare system. Furthermore, the current position of the Canadian Telecom companies were obtained from their individual websites.

The following analyses were used in determining whether Telecom companies can implement a healthcare IoT strategy: SWOT Analysis, PESTLE Analysis, VRIO Framework, Triple Bottom

Line Analysis, Porter’s Five Forces, BCG Matrix & Value Chain Analysis. Each of these of analyses focused on Canada’s healthcare issues and how Canada’s telcom companies can help solve these issues. It became apparent that Canada’s telecom companies are ready and willing to engage in this new line of business by leveraging their current network infrastructure and IoT strategies.

5.0 Analysis:

Improvement in the telecommunication industry has huge implications in both the banking and health industries. The main objective of Canada' Domestic Health ICT sector is to improve the direct and indirect labor-force in the health sector of the economy. The present healthcare requires a significant influx of IoT that further facilitates information sharing. Almost 60% of the population in Canada does not possess considerable amount of healthcare related information.

It has also been identified that the initiative taken by telcos has facilitated information sharing.

Studies have shown that the present managerial attribute of the nation is not efficient towards understanding managing healthcare facilities throughout the world.

Relative to other nations like the US and China, Canada is not taking advantage of IoT solutions.

According to the interview analysis it has been observed that introduction of 5G has positively influenced the scope of IoT in the field of healthcare and communication. IoT information sharing, providing access of medical information to both the medical community and to the public, can improve the efficacy of the entire industry. Almost 60% of the medical facilities recommend the use of IoT for a better economic prospect. Furthermore, the increased amount of human intervention can reduce almost 49% of the total setup cost required by a healthcare facility.

5.1 TELCOS Implementation Strategies and Resources

According to Luna et al. (2014, p.3), in order to improve their efficiency level the employees should be provided with technological resources. These have been proven to assist in the analysis and collection of health information. This provides medical professionals with research on disease outbreaks in Canada along with cost-cutting methods to treat these diseases

(Holroyd-Leduc et al. 2016, p.23). Implement of telehealth and digital prescriptions will require software advancements and workers skilled in this software.

Office 365 has played a major role in telehealth - telecommunication services in healthcare.

Skype for Business (SFB) “provides communication services for telehealth, telemedicine, tele- collaboration, remote patient monitoring, and care coordination” (Dhru 2018, p. 83). SFB also

“supports instant messaging (IM) and audio and video calls, as well as presence indicators to facilitate communication between clinicians and physicians exchanging critical information,”

(Dhru 2018, p. 83). SFB has also been implemented in post-discharge cases where patients must report back their health status at regular intervals (Dhru 2018). Instead of traveling back to the hospital patients can now report their updates from the comfort of their homes using SFB

(Dhru 2018).

In her book Office 365 for Healthcare Professionals: Improving Patient Care Through

Collaboration, Compliance, and Productivity author Nidhish Dhru discusses Office 365 as used in telehealth, but also for businesses in general. Dhru states that Office 365 can be used in many different ways “such as scheduling appointments, searching for contacts, automated responses

47 based on chat bots, and many other such use cases. SFB provides infrastructure in the Microsoft cloud so providers don’t have to worry about setting up infrastructure in their facilities. As long as either patient or clinician has access to the internet and some sort of device, whether it’s desktop, laptop, tablet, or phone with browser or app and a camera, they should be able to use the SFB services. All the services in Office 365 including SFB are HIPAA complaint, with encryption end-to-end and continuous monitoring of fraud alerts.” Softwares like Office 365, as implemented in the Canadian Healthcare system, can decrease waiting time in between hospital visits. It can also be a valuable resource for doctors as they can share information on treatments and procedures through telehealth. Furthermore, “patients benefit from having access to leading medical experts miles away from their home who can provide virtual care and personalized real- time treatment while the patients remain in the comfort of their own homes,” (Dru 2018, p.75).

This will save patients time and make nurses and doctors more efficient.

5.2 The Canadian Government’s Role

Both private and public sectors need to collaborate to improve technological researcher. Public sectors and governments need to give subsidies to the overall costing of the various firms that are investing in the health sector. It is predicted that 82% of employment will increase in the health sectors in Canada in the next 12 months (Ictc-ctic.ca, 2018) While almost 44% of R&D will be increasing in the next few years. The expenses behind Canada’s Domestic health sector investment will increase by $210 million annually. Currently, the domestic information and communication technologies (ICT) health sectors generates about annual revenue of about $3.4

48 billion which contributes to GDP of Canada by $1.5 billion. The role of the government is massive in successfully integrating IoT or 5G network capabilities in the health care system. This is because the federal government subsidizes taxes to pay for the current expenses accumulated by health services. In controlling the flow of money to hospitals and clinics, the government has a direct connection to all health services and can assist and ask them to implement new technologies that they feel will improve the efficiency of their service as well as decrease costs.

In doing so, the government will endorse the use of IoT solutions and promote further development of the technology. This will catalyze the growth of the public and private sectors of healthcare as both types of companies will be motivated to use new tech. On the contrary, if the government does not promote or endorse the use of this technology, they run the risk of being left out of the technological race and will most likely be forced to implement reactive measures to control the growth of the private sector as they will be the leaders in the space. If the private sector takes over the integration of new tech, the government will be paying more money to roll it out nationwide. This is why it is so important to invest in new technologies as well as research the potential uses.

5.3 Future Outlook of Health ICT of Canada

With regards to the below-mentioned challenges that the domestic health sector is facing; the government has increased financial support in order to improve the research techniques, innovation of new products and segmentation of markets. This will make product delivery more efficient. About 59% of total government spending is spent in supporting the research techniques. The federal government has increased funding for digital health and innovative technologies by 54% (Lauckner et al. 2016, p.3601). The government is focusing more on the upgradation of the skills of medical professionals. Thus with stakeholders funding, the government’s new healthcare budget has increased 41%. For further enhancements, private telecommunication companies need to join with the government initiatives so that they can deliver better services (Maheu et al. 2018, p.108).

Table 2: Challenges that the health sectors are facing

Variables Percentage (%)

Lack of desire to implement new 59 changes

Lack of capital investments 49

Lack of government support 47

Lack of funds to improve the skill of 31 employees

Lack of awareness 30

High competition 29

Lack of skilled employees 21

Lack of collaboration with other 19 healthcare providers

(Source: Ictc-ctic.ca, 2018)

Figure 22: Percentage of Challenges faced by health sectors (Source: Ictc-ctic.ca, 2018)

5.4 Segmentation and targeting of the market for the health sector

The value of IoT in health sector of Canada will be $409.9 billion by 2022 (IoT business news,

2016). With the recent improvement in curing chronic diseases and increased demand for short and long term treatments have increased the value of modern tools and especially the internet and its applications. Advanced disease management system have led to segmentations of the market, targeting a specific customer group having chronic illness. The Internet of Things, have induced the growth of advanced technologies in the detection of remote clinical testing. Client awareness of this testing has promoted the development of mobile applications in monitoring the health status.

Setting up the targeted market and consumers will require the innovations in the system and development of software and medical devices.

Figure 23: Impact of IoT in the health sector of Canada (Source: IoT business news, 2016)

The diagram above shows the trend of developing devices, software and systems and services which will continue to increase till 2022.

5.5 Valuation of the IoT in health sectors

During the period of 2013-2015, the rate of wearable medical devices has taken the market share of about 60% (IoT business news, 2016). With the improvement in the connectivity in the form of Wi-Fi or Bluetooth and these devices are expected to increase by 30%. In the upcoming period, the valuations will be worth $309B within 2022 (IoT business news, 2016). IBM has announced to invest more than $3B USD for Internet of Things, particularly to invest in the health sector which will definitely increase in near future. Microsoft has developed Microsoft Azure cloud platform in delivering cloud based healthcare services. In the upcoming time, the Internet of things is going to take vertical lead. The IoT is changing the dimension of the business from

$2.88 billion in 2013 to $6.5 billion in 2018 (Itbusiness.ca, 2015). In the global market, the IoT is growing by 12.5% in the same period, from US$1.3 trillion in 2013 to US$3.0 trillion in 2020.

5.6 TELCOS and their Impact on Canadian Health Services

Almost all the developed countries have used information communication in order to improve the health sectors. Companies such as BoltonSmith, BroadConnect Telecom, Brooke Telecom

Co-operative Ltd are helping in the development of the health sectors. The incorporation of these telecommunications is creating a public and economy demand for better healthcare facilities in

Canada (McPherson et al. 2017, p.100). Connecting Canadian economy with the rest of the world will improve existing technologies and introduce new technologies. Introduction of mobile platforms has doctors and the general public check health statuses from anyplace (Terry et al.

2016, p.19). According to Young et al. (2016, p.6); using interconnected technologies and improving relationships with the stakeholders, can resolve and avoid further economic and infrastructural issues. It can also provide a medical record keeping system. Improvements in the overall structure will be beneficial for the economy in delivering better healthcare facilities and the improvement in the telecommunication will minimize the lack of accessibility of the indigenous group of peoples in the health sectors.

However, there are also various challenges that need to be addressed for effective implementation of IoT (Thuemmler & Bai, 2017). Such challenges include the need to standardize different applications, software, and devices to ensure appropriate collection and analysis of data. Moreover, the standardization will help ensure cooperation between different agencies within the healthcare system. Another challenge lies in the need to ensure confidentiality and protect the data of patients and other agencies within the healthcare system

(Geissbuhler, Demongeot, Mkhari, Abbdulrazak, & Aloulou). Canada faces various technological and systemic challenges, particularly in relation to how fast IoT technologies can be implemented. This is more so due the need to comply with numerous regulations particularly in relation to patient privacy and confidentiality (Jeschke, Brecher, Song, & Rawat, 2016). This implies that creating and implementing IoT would require adequate understanding of regulation that governs the Canadian health and technological areas. Moreover, it would require establishment of appropriate mechanism to evaluate, monitor, and frequently monitor the

54 creation and implementation of IoT to ensure that adjustments are made from time to time

(Marchildon, 2013). This will help ensure that it is up to date and capable of collecting and analyzing data, as well as prevent potential access of confidential information by non-authorized parties (Eshed, 2016). This essay focuses on analyzing how Canadian's telcos & IT companies can create and implement a Health Care IoT Strategy, utilizing their existing network infrastructure to address the issues in Canadian Healthcare System. This will entail conducting an analysis of Canadian health system to test the probability of implementing IoT. Various tools will be used inclusive of Porters 5 forces, environmental analysis, benchmarking (industry best practices), BCG matrix, value chain analysis, triple bottom line and other theories relevant to implementation of IoT in the Canadian health system.

5.7 SWOT Analysis

Bell Canada

Strengths

Bell Canada possesses several strengths as this company’s network is widely distributed. Bell

Canada deals with popularity. This company gives good advertisements and has a big brand presence all over Canada. Strong Financials and spend a lot on Research & Development. Bell has 80% of the fiber foot print in Canada. They have 33% more wireless towers than the other telcos.

Weaknesses

Bell Canada has a dependency on the subsidiaries. This company has bad reputation because of its misleading prices and censorship. Too many silos and company has several decentralized

IT Systems.

Opportunity

Bell Canada has global strategic acquisition portfolio. This company is currently implementing

5G technology. Has the financial resources to acquire HealthCare companies via Merger and

Acquisition

Threats

Bell Inc Company has threats from the new players that are rising in the business. Changing that is occurring in the policies of the government regulations are also a threat to this company.

Rogers

Strengths

Rogers has a variety of business operations; from media to telecommunication to sports. This company has large customer base. This company has a strong brand. Rogers has strategic business initiatives which help in the enhancement of the consumption and diversification of products by the customers. Strong Financials

Weakness

This company consists of limitations in its global presence and hence has limited customer base.

This company depends mostly on the Canadian market. Not agile. Big Teams.

Opportunity

Rogers has an opportunity of capturing the market by launching their first ever WIFI Smartphone e-service. This company can increase telecommunication in Canada.

Threats

This company has stiff competition; Bell and TELUS. Rapid changes in technology are threat to this company.

TELUS

Strengths

This company runs efficiently and has a strong lead in the Canadian market. It has large base of customers. This company consists of Strong brand image. This company has the next generation telecommunication infrastructure. TELUS has diverse business endeavors.

Weakness

TELUS wireless network performance has declined. This company has a poor global presence.

Opportunity

TELUS expects growth in their telecommunication industry. This company is investing new 5G technology and LTE-M technology (low power LTE). Currently share the network infrastructure with Bell Canada

Threats

TELUS has high competition. This company possesses threat in regulatory policies. This company is unlikely to change government policies.

(Please see Appendix 2 for SWOT Table)

5.7 VRIO Framework Analysis – See Appendix 2:

5.8 Value Chain Analysis:

Rogers Value Chain Model

Figure 24: Rogers value chain analysis (Source: Hartlen, 2015) Rogers uses the best technology in the Canadian market. Rogers competition is; Telco, BEll Canada, and Shaw communications. Rogers does its operations in three areas which are 1. One, is wireless data and voice communications. Rogers is the largest wireless provider in Canada.

2. The second, is cable services. Rogers is considered to be the largest provider of television cable services. They also provide high speed internet access, video calling retailing and services of telephones. 3. The third service of Rogers is media that includes radio and television broadcasting, trade publications, sports, magazines and television shopping. Rogers’ backbone is considered to be its distribution channels; consisting of 3,600 Rogers owned dealers and retail outlets. Chief goal of Rogers is to maximize its subscribers and stand as the best media and communication provider.

TELUS Value Chain analysis

Figure 25: Telco Value Chain analysis (Source: Hartlen, 2015)

TELUS is one of the largest data and wireless providers of Canada. It provides internet protocol and wireless and voice communication services. Its aim is to provide full communication services. TELUS’s expertise lies in a single facet.

TELUS’s conferencing solutions consists of a host of services and products which are designed to allow meetings to be conducted by multiple people, from multiple locations, on multiple devices. Conferencing solutions consist of audio conferencing, web conferencing, and video conferencing.

Audio conferencing

This conferencing best used virtual meeting solution provided by Telco. Through this solution multiple participants are joined together in a virtual meeting. Telephones are used by customers for placing their conference call.

Video conferencing

In this multiple participants are allowed to call from distant locations via visual and audio communication.

Web conferencing

This process is also called as data conferencing which is the newest form of conferencing technology provided by the Telco conferencing industry. Customers can also web conference meetings.

Bell Canada Value Chain Analysis

Figure 26: Bell Value Chain Analysis (Source: Goodwin, 2012)

Bell Company is said to provide the best human resource and developed technology services in

Canada. This company provides the outbound and inbound logistics services. It also provides marketing and sales services that has gained significance in Canadian markets. This company’s services help the development of technology. It can be said that the primary activities of this company include providing general administration and procurement. Bell Company’s services are reliable and convenience.

5.9 Social macro trends

A social macro trends is a social process or activity that involves a persistent shift in the usual phenomena such as automation, and the internet. Social macro trends in health have been especially effective; increasing global standards of health and higher healthcare spending in many countries. Use of the internet has especially advanced healthcare with shared research and collaborative research which has resolved IT issues and promoted problem solving.

Healthcare expenditure, which is a share of state and local revenue, has increased from 16% in

1987 to 21% in 2000 and to an increase of 31% in 2013.

Figure 27: Trend timeline (Source: Seekingalpha, 2016)

Figure 28: Healthcare expenditures (Source: Seekingalpha, 2016)

5.10 PESTLE Analysis; Political, Economic, Social, Technological, Legal and

Environmental Factors

Political

The Canadian government has been trying to reduce its spending and increase its savings across the board through ways such as reducing their spending in different sectors including healthcare without reducing the quality of care (Jeschke, Brecher, Song, & Rawat, 2016). This implies that there will be pressures on telcos and IT companies to minimize the costs of creating and implementing the healthcare IoT strategy. Furthermore, there will be political pressure to

63 implement the IoT strategy fast and harmonize the healthcare system, putting the companies under strict deadlines (Eshed, 2016).

Economic

Canada has been increasing its spending in the healthcare system with the aim of enhancing accessibility and quality. Moreover, there has been growing research with the aim of understanding healthcare related issues across different populations within Canada

(Marchildon, 2013). This implies that Canada would be willing to invest in the IoT strategy if telcos and IT companies are involved. Moreover, the strategy has the capacity to help consolidate and harmonize healthcare services across Canada (Zhou & Salvendy, 2017).

IoT components are often characterized by low capabilities in relation to utilization of energy and computing resources. This implies that there is need for telcos and IT companies to conduct extensive research on how create and implement an IoT in a way that will maximally the utilization of energy and computing resources (Marchildon, 2013).

Social

Canada is characterized by high levels of inequality and income disparity. Furthermore, Canada has an aging population, which offers a wide range of threats as well as opportunities in creating and investing in IoT (Zhou & Salvendy, 2017). However, the Canadian population is increasingly becoming informed about healthcare issues, creating a demand for a greater quality of services.

With the increasing public activism, telcos and IT companies will have to effectively harness and

64 combine their resources such as knowledge and avoid overstepping the existing regulatory boundaries (Eshed, 2016).

Technological

The challenges facing IoT implementation are largely technological. Basically, implementing IoT entails using Networks with automated discovery capabilities. The applications are installed or connected to ‘things’ that are mobile. According to Maresova, Penhaker, Selamat, and Kuca

(2015), IoT potential is best realized when utilized in not-static environments to collect and analyze vast amount of data. However, there are challenges associated with these movements since new entities need to be added all the time. Moreover, there is need to ensure that the different entities are appropriately connected so that they can work seamlessly with one another

(Thuemmler & Bai, 2017).

Another technological challenge currently facing IoT implementation in Canada has standardization issues. IoT is something that will keep evolving with time. Therefore, there will be constant need to review any regulatory and other constraints and come up with ways of ensuring that there is sufficient capacity to expand the IoT to its full potential (Thuemmler & Bai,

2017). Therefore, there will be constant need for review and establishment of new radio spectrums to ensure that different agencies and entities within the healthcare system are able to cooperate. Moreover, there is need for constant review and evaluation of the IoT networks to ensure that they operate effectively (Marchildon, 2013).

Legal

Canada has numerous legislative regulations. Furthermore, the culture of ligation influences telcos and IT companies to be innovative when developing and Implementing IoT, to comply with existing regulations and rights of patients. Implementing IoT involves different government agencies within and outside of the healthcare system. Moreover, there are a variety of government and private agencies involved and various regulatory requirements concerning technology and privacy issues that must be addressed (Zhou & Salvendy, 2017 and Eshed

2016). The evolving nature of IoT means that there will be constant need to review the regulatory constraints and protect vital information. Before, telcos and IT companies manage to standardize

IoT and meet the legal and other regulatory requirements, devices will have to make use of multiple protocols and frequencies (Marchildon, 2013).

According to Centric Digital(2016), IoT networks are vulnerable to third party hacking, given that most of communication are wireless. This makes it possible for unauthorized parties to intrude and eavesdrop on important transmissions which can affect the authentication and integrity of data (Mantas, Hasman, & Gallos, 2017).

Environmental

Business operations in Canada need to be more proactive in enhancing environmental protection. Given the growing concern over the effect of electromagnetic radiation, telcos and IT companies need to reduce the effects of their electromagnetic releases into the environment.

The companies will have to come up with eco-friendly ways of implementing strategies to limit their effect on the environment (Thuemmler & Bai, 2017).

5.11 Porter’s Five Forces

Digitization entails revolutionizing the rules of competition amongst existing companies or entities. IoT involves developing smart and highly connected devices embedded within a wider system. This will reshape the competition between the public and private entities within the

Canadian healthcare system. Porter’s five forces that can best help understand the dynamics within the Canadian healthcare system include buyer’s bargaining power, rivalry among competitors, suppliers bargaining power, threat of new entrants, and threat of substitutes

(Marchildon, 2013).

Buyers Bargaining Power

According to Centric Digital (2016), IoT will dramatically change and reshape the Canadian healthcare system. Utilization of smart and highly connected devices is likely to lower the buyers bargaining power since competition will be largely based on service differentiation. Implementing

IoT is largely about tailoring products and fixing prices to ensure that better healthcare services are extended to users (Zhou & Salvendy, 2017). IoT will help strengthen the relationship between patients and different parties within the Canadian healthcare system by enabling them access their records and service usage and the cost of switching to other alternatives. Alternatives include private healthcare providers not connected to the public healthcare system. As service

67 delivery becomes further embedded into the healthcare system, buyers will gain bargaining power (Marchildon, 2013).

Rivalry among Competitors

Rivalry among competitors will largely reduce. Competition in the Canadian healthcare system exists between the private and public healthcare providers. Implementation of IoT will mean that there will need for more cooperation between the private and public healthcare providers, as will be largely based on value of services (Mantas, Hasman, & Gallos, 2017). However, there will be growing competition among IT companies on developing smarter devices to meet the technological needs to help realize the creation and implementation of IoT. However, the cost of producing these goods, in development, implementation and maintenance, may be greater than the revenue. There is high cost involved in providing IT infrastructure for effective functioning of

IoT strategy (Marchildon, 2013). Thus, the companies will be under pressure to increase prices.

Threat of New Entrants

Within the Smart Connected world, there are high costs of entrance and numerous barriers, meaning that the threat of new entrants is high and only the mighty and experienced companies are largely involved in projects of high magnitude such as IoT development and implementation

(Zhou & Salvendy, 2017). Complex product design, the high costs, and need for highly experienced workers will form considerable barriers for new entrants wishing to compete with telcos and other established IT companies (Mantas, Hasman, & Gallos, 2017).

Threat of Substitutes

New products with great performance, customization, customer value, and effective smart products will encounter minimal rivalry from the existing conventional products. The threat of substitution is little but there is a high demand for smart products that function within the healthcare system, which IT companies will, in turn, invest in. Therefore, emerging business models within the healthcare system will facilitate development of substitute products

(Thuemmler & Bai, 2017).

Suppliers Bargaining Power

According to Maresova, Penhaker, Selamat, and Kuca (2015), smart and highly connected products continue to revolutionize the supplier associations. In relation to IoT, the bargaining power of traditional suppliers over their healthcare providers will decline as the demand for physical product constituents will decrease. However, giant IT companies will have higher bargaining power since their smart products and services will be in high demand as they will be constantly reviewing and updating their products. This will increase their bargaining power

(Mantas, Hasman, & Gallos, 2017).

A report conducted by analysts at Goldman Sachs concluded that investing in digitally connected devices to establish IoT could reduce the healthcare costs by $300. IoT continues to be utilized in countries across the globe and has helped address major health challenges especially in low to middle income countries, with remarkable results (Ackx, et al., 2015). In countries such as UK

IoT devices have helped streamline workflow and enhance treatment to prevent chronic health conditions. Furthermore, IoT has helped in monitoring patients living in remote areas in countries

69 such as US (Thuemmler & Bai, 2017). Moreover, IoT usage in telemedicine, in countries such as UK has helped reduce treatment required and improve patient outcomes. Therefore, healthcare IoT has the potential of changing the approach to patient care and will help boost healthcare outcome by obtaining data and tracking patients, particularly those with chronic and life threatening health conditions (Ackx, et al., 2015).

As healthcare IoT evolves, use of IoT will become increasingly necessary to help track patient vitals, stress levels, diet, and other health indicators. It will also enable data to be shared amongst care providers for improved services (Marchildon, 2013). In countries such as U.S and turkey, IoT has detected information, often left out in patient self-reporting. This provides a better and complete picture of patient health, helps improve treatment, and prevent illness. Therefore,

IoT will streamline the Canadian healthcare industry operations. Care providers will be able to spend less time on administrative task and allocate more time to patient care (Ackx, et al., 2015).

5.12 BCG Matrix

BCG matrix classifies business into industry attractiveness and competitive position. Although vast amounts of capital will be required to invest in the healthcare IoT strategy, the benefits to be achieved are high (Ackx, et al., 2015). Furthermore, the healthcare industry is broad. Different

IT companies can invest in different areas depending on their area of specialization. These specializations include; patient monitoring, clinical operation and workflow optimization, drug development, fitness and wellness evaluation, and imaging and diagnostic (Marchildon, 2013).

The competitive position of IT companies depends on their capacity to create products that are tailored to the existing network infrastructure and address the existing challenges. However, telcos has a considerable market share and higher capacity to invest in different sections of the

Canadian healthcare system (Zhou & Salvendy, 2017). In relation to market growth rate, the investment required to create, implement, and review IoT is high. By investing in a large market share, IoT healthcare will also increase the future market share and earnings (Mantas, Hasman,

& Gallos, 2017).

In relation to BCG matrix for Canadian healthcare IoT, the dog quadrats would include sectors such as patient monitoring. The cash cows are areas such as drug development, health promotion, and fitness and health, which are becoming increasingly profitable (Geissbuhler,

Demongeot, Mokhtari, Abdulrazak, & Aloulou, 2015). Cash generating areas include; diagnostic and treatment sectors. While unprofitable areas may include; clinical operation and workflow optimization (Marchildon, 2013).

5.13 Triple Bottom Line Analysis

Implementing IoT would require strategies to enhance sustainable growth and performance

(Gerwig, 2014). Triple bottom line analysis is a tool that focuses on the financial bottom line. It analyses components such as social and environmental responsibilities. It helps measure the social responsibility, economic value and environmental impact of a company. The triple bottom

71 line goes beyond measuring the profits, shareholders’ value and return of investment and is thus capable of assessing environmental and social dimensions, which are crucial in healthcare

(Bhatt, Dey, & Ashour, 2017).

In relation to IoT, triple bottom line is an appropriate way of using technology to increase efficiency. In relation to social measures, IoT has the capacity of improving access to healthcare resources; and improving the quality of life, health and overall wellbeing of Canadians (Eshed,

2016). Although IoT will have various environmental implications due to emissions such as electromagnetic radiations, the damage can be minimized since implementation will largely involve utilizing the already existing systems and updating their features (Katsaliaki & Mustafee,

2015).

IoT is a tool that will enable the triple bottom line in cooperating social responsibility (Gerwig,

2014). In healthcare IoT will promote solutions that have a positive environmental and health impact. IoT can deploy sensors to understand the happenings across different sectors of the healthcare as well as measure Canadians’ wellbeing, particularly in relation to issues such as chronic diseases and age related conditions (Bhatt, Dey, & Ashour, 2017). This will make healthcare provision more sustainable since it will be possible to access different areas of healthcare from one location and connect different systems. The Canadian healthcare system needs to embrace environmental stewardship by using ethical principles such as beneficence, non-maleficence and justice with the aim of promoting the wellbeing of the community (Katsaliaki

& Mustafee, 2015). Through using triple bottom line tool, it is possible to assess the capacity of

IoT to achieve objectives such as enhancing savings in healthcare, increasing healthcare

72 accessibility, and improving healthcare outcomes. It will thus be possible to make appropriate adjustments to increase the potential of IoT to protect and promote health (Gerwig, 2014).

5.14 Results

During the depression years, the need for public healthcare grew and this led to Tommy Douglas putting forth his model of public healthcare in Saskatchewan in 1962. It was Tommy Douglas’ vision that every Canadian, regardless of social or economic status, should have access to public healthcare. Since 1966, Canada’s public healthcare system has gone through significant evolution. Despite government commitment to preserving the healthcare system, there are several gaps and inefficiencies in the healthcare system. Some of the issues include long wait times, the systems are too costly to operate, it is wrought with inefficiencies; the Canadian population is ageing, and there has been an increase in chronic disease and illness. The main purpose of this conceptual paper was to determine whether the Canadian Telecom companies can leverage their existing network infrastructure with IoT to assist with the problems faced by the Canadian healthcare system. To achieve this goal, the paper undertook a qualitative approach by examining various data from scholarly articles, media articles on healthcare, case studies, healthcare blogs and an examination of current solutions offered by Canada’s big three telecom companies (Bell, Rogers and TELUS). The key findings of this paper was that by implementing IoT and 5G via various communication companies, the Canadian healthcare system can become more efficient; through new technological advancements and communication between medical professionals and the public.

In comparison to other commonwealth countries, Canada ranks behind in providing quality health care to its citizens. In addition, Canada is not taking advantage of IoT solutions for healthcare. Almost, 60% of medical facilities recommend the use of IoT for a better economic prospect. Furthermore, the increased amount of human resources can be reduced by 49% of the total setup costs required by a healthcare facility. According to Luna et al 2014, pg. 3 – in order to improve the efficiency of healthcare employees, they should be provided with the latest technological resources. By implementing and using new technologies such as IoT, this will hopefully prevent disease outbreaks in Canada and make the system more accessible to

Canadians coast to coast. Increasing costs on medical per person is rising. In 2017 the average medical spend per Canadian was $6604, almost $200 more per person than in 2016 ($6,419) and the Canadian government spent over $240B in Healthcare.

Both private and public sectors need to collaborate to improve technological research. The public sector (governments) need to give substantial subsidies to the Canadian telcos, in order to encourage them to invest in the healthcare sector. Currently, there is a lack of desire to implement new changes, a lack of capital investment and lack of government support.

Approximately, 59% of total Canadian government spending is focused on supporting the current research techniques in healthcare. Even though, the Canadian government has increased funding for digital health and innovative strategies by 54%, there still remains a significant gap in funding of new healthcare technologies. Canada’s telcos collectively have capital resources required to help bridge this gap. They must lobby the Canadian government to provide substantial grants/subsidies so that the Canadian telcos can develop and implement a healthcare IoT strategy.

Through the analyses of SWOT, PESTLE, VRIO Framework, BCG Matrix, Porter’s 5 Forces,

Triple Bottom Line and Value Chain Analysis, we can see that there is a key role that the

Canadian telcos can play in addressing the problems faced by the Canadian healthcare system.

It is hoped and encouraged that each of Canada’s telcos (especially the “Big Three” – Bell,

Rogers, TELUS) take a hard look at this analysis and commit significant financial resources to research and development in this area.

6.0 Recommendations

6.1 Recommendation for Telcos on implementation of Healthcare IoT Strategy

With the rise of technologically advanced civilizations, we must aim, as a nation, to maintain a competitive advantage in order to compete on a global scale. The primary concern for the modern day telecommunication companies in developing IoT technologies is found in the vulnerability of security. IoT requires significant infrastructure that is engineered towards protecting the data during all phases of the process. Developing new software that improves security and minimizes risk would solidify any telco company entering the space. Another significant consideration can be understood as the use of cryptographic techniques towards securing IoT structures from any unauthorized access. The modern day telecommunication industries also a face significant amount of complexity towards data volatility. Digitalization of data have made data storage more vulnerable. A number of vulnerabilities are currently stagnating IoT solutions that include; security weak points in regards to stored data in centralized locations; the speed of the transfer of data; and the encryption of such data. I believe Rogers

Communications and Bell Canada both have the capabilities to integrate IoT solutions that can tackle these issues.

A company like Rogers Communication has the infrastructure and balance sheet that would allow for the technological advancement and integration of IoT solutions. If Rogers were to utilize

IoT software into their existing customer database, we can test the efficacy and effectiveness of the program and identify any issues before attempting to integrate it into the healthcare system.

Integrating any IoT strategy into a large, central database poses significant risks. The integration process should be treated with caution.

A company like Bell Canada have already made strides in testing IoT strategies in a developed city. In Kingston, Ontario Bell has rolled out a Smart City program that aims to increase the connectivity of people and devices. This includes any services that are offered in the city. Testing a complex web of connectivity serves as a progressive step towards implementing more sensitive data. Most recently in 2017, Bell Canada acquired Alarm-Force which provided Bell with a solution for Remote Health Monitoring solution. Bell Canada could enhance this solution by integrating it to its IoT Platform.

The companies above are the two most likely, and capable, to comprehensively implement IoT solutions in Canada. As both of these mega corporations own a significant percentage of market share, they could both battle to acquire dominance in the main cities.

6.2 Recommendation to Build a Healthcare Service Mobile App

One of the most important facets of technology in healthcare is the idea that healthcare must be accessible at all times for consumers. To achieve this end, Telco’s must create a solution that will allow consumers to have access to real-time health information. One way of achieving this goal would be to develop an App that is accessible across multiple platforms. This App would allow consumers to have access to doctor’s offices in order to make appointments, check

77 hospital wait times and prescription drug management. App development by Bell, Rogers and

Telus would give each of these companies’ greater access to the healthcare market by providing their consumers with a user-friendly easily accessible health solution. The cost of development of this App would be minimal and can be done in-house tailored specifically to the need of the

Telco. Many telecom companies offer their customers comprehensive services such internet, mobile connectivity (through smartphones and tablets), television and home phone, by adding a health app this would give telecom companies an extra edge in a competitive market place.

Furthermore, telecom companies can this offer this App based solution to business customers such as insurance companies and private healthcare providers. Over the long term the

Canadian federal government and provincial governments would benefit from a more streamlined based approach that an App can provide. It must be remembered that the creation of an App will not solve all the problems of the Canadian healthcare system, but it would be a huge step in streamlining and making a complex system more accessible for all Canadians coast-to-coast. Finally, with the advent of 5G technology in Canada this will provide the power and data needed to make an App comprehensive in terms of healthcare information. It will allow consumers to have quick access to the healthcare services they need with real-time data in a secure and private fashion. I would strongly recommend that Canada’s telecom companies spend some amount of their R&D on developing this App and have it ready for consumer use in the next two years when the same 5G technology will come to Canada

6.3 Recommendation for Partnerships and Collaboration

Partnership of medical services with the established IoT related companies can develop a mutually beneficial healthcare. Collaboration can be understood as an effort made by both the healthcare agencies, telco companies, insurance companies and government agencies; who are all needed to work together with the aim of creating sustainable solution of healthcare and management in mind. With accordance to the collaborative effort made for the development of

IoT technologies, relevant applications can be developed and used in different prospects of appointment and online medical counselling. The transfer of information from the medical sector to the technical sector can cause an overall development of both the healthcare and IoT facilities.

As mega corporations and governments collaborate, effective and sustainable solutions can be developed and integrated that will benefit the entire nation.

6.4 Recommendation for Breaking down Barriers with Government

Currently, the Canadian citizen pays for healthcare for the entire nation via taxes. In this system, there are weak points and areas that can be improved upon with the implementation of new technologies like IoT. The present IoT structure of the nation is not competitive and requires significant investment if the technology is to be integrated to a degree where it revolutionizes the way data is transferred and secured. The speed required for IoT is not adequate compared with the current technical architecture of the nation. A collaborative effort made by the governmental organizations towards different IoT related organizations can help in improving the IoT healthcare services for the nation. With adequate investment, the integration of IoT solutions

79 can evolve the Canadian healthcare system for the better. Collaboration and investment from telco companies and government agencies are essential in breaking the barriers the government holds as it will lead to a more sustainable and prosperous future for all Canadians.

6.5 Recommendation for Insurance Companies

Insurance companies can play a significant role in popularizing the use of IoT in health sectors.

In modern society, health insurance is one of the most fundamental considerations for the modern generation. The insurance companies can promote the use of IoT for availing insurance services relating to healthcare. It is recommended that insurance companies should offer promotions and discounts for the use of IoT towards. In particular, promotions should be geared towards, making payments and availing services. Use of online medical consultants can significantly influence the popularity of IoT. Medical consultants can be utilized for accessing personal health and recommending suitable insurance policy based on analyzed results. The ease in which medical professionals and insurance brokers will be able to access data can help towards popularizing IoT for different medical purposes.

6.6 Recommendation for Implementing IoT Healthcare services in Canada

As Canada is one of the most developed nations in the world, it requires a significant amount of consideration if they are to successfully implement a sustainable framework that incorporates

IoT solutions in healthcare. It has been observed that the nation lacks significant amount of technical infrastructure required for sustaining IoT services. As discussed above, the internet speed for the nation is not capable in offering IoT services. It is recommended that the Canadian government should understand the importance of IoT and collaborate with telecom companies in developing a sustainable IoT framework for the nation. It is also recommended that medical representatives take the initiative in popularizing the use of IoT solutions for healthcare among patients.

7.0 Conclusion

Canada’s healthcare system has been subject to numerous political debates and controversies with serious questions being asked about the efficacy of the current system and its capacity to deliver timely treatment and other healthcare services. IoT strategies can improve public healthcare outcomes and productivity. IoT will help enhance cooperation/collaboration between different healthcare providers as well as harness and maximize the use of this technology. In particular, the collection and storage of healthcare data and its uses. However, telcos and IT companies will be faced with challenges such as the high capital investment required to develop and implement healthcare IoT that is engineered for the Canadian healthcare system. Other challenges will include the growing demand for quality services as well as the need for highly experienced workers that can implement and constantly evaluate the effectiveness of the IoT framework. One of the biggest problems facing telcos with regards to the collection and use of healthcare information is the security of personal healthcare data. The main question that needs to be addressed is how can telcos protect sensitive healthcare data from hackers and other malicious users. Furthermore, there are significant issues with regards to privacy of information, many Canadians will be concerned that 3rd party companies such as telcos will have significant access to private information regarding health. To ensure that Canadians privacy is protected, the telcos will have to develop or retool their IoT strategy to take into account federal privacy legislation. Nevertheless, these issues can be overcome if the Canadian telcos work closely with the federal and provincial governments in developing a secure healthcare platform for all

Canadians. Canadian healthcare system is under significant amount of strain, new and more efficient solutions need to be found quickly. As our population ages, there will be tremendous

82 added pressure to an already overburden system, IoT can help to address and solve some of these issues. The Canadian telcos must therefore cease this opportunity to develop a sustainable healthcare IoT strategy that uses 5G, Fibre Optic Infrastructure and Data Centres.

Lastly, the Canadian telcos can leverage their current bargaining power with consumers by giving them complimentary solutions to their already pre-billed consumer packages.

APPENDIX

APPENDIX 1: Improvement of IoT in healthcare industries

Industries Past (1980’s) Present (2010 onwards) 2018 and beyond

Banking Limited number of With the development of The future of financial ATM and bank mobile banking and internet services can be identified as branches banking, the services are the introduction of E- now open for 24*7 making currency. E-currency can be the patient party more understood as digitalization comfortable as they can of currency with the help of withdraw money or make future developments in data payments from anywhere security. Recent anytime. developments in the field of e-currency can be understood as the introduction of bit coins.

Traveling Previously limited With the improvement in the The future of traveling travel agents were online booking system, the industry can be identified as there and limited human being across the interspaced travels. locations were globe does not need to face Organizations like Tesla are available in order the agent's drama and high slowly developing new to avail better charges taken by them and technologies to facilitate healthcare individuals can travel interspaced travels. services anywhere in search of better healthcare services.

Retail In the retail With the facility of online The introduction of marketing marketing, earlier shopping nowadays, the readymade food items can the suppliers used hospitals and the healthcare be understood as the future to control the institutions can get the of the retail market. In this market with their supply of the surgical era of busy lifestyle focus is supplies. instruments and drugs being given towards

Previously many without getting bothered development of readymade cases have been about the agents and instant food items which can found where the suppliers. Strong be carried along. hospitals and collaboration among the nursing homes suppliers from the global faced lots of phenomenon also helps problems as the these institutions in getting agents called bulk products cheaply. strikes as they stopped the supply of many surgical instruments and drugs.

Healthcare Along with the However, with the Development of online services improvement in improvement in the medical consultancy the internet and communication and applications and availability mobile platforms, information system, of dedicated medical portals the provision of nowadays, the patients can for emergency times can be health care also book ambulances from the understood as the future of improved. mobile applications itself. healthcare services. Previously in the While booking a bed in early period, the hospitals now the common patients had to people do not have to face face a lot of the middleman and that can issues in simply be done easily through booking an mobile applications. ambulance to take the patients to hospital (Hu et al. 2015, p.259). Lots of middlemen emerged due to lack of proper channels.

Pharma Previously it was With the development of The introduction of instant impossible to get various pharmaceuticals energy drugs and instant rare medicines on applications such as E-med healing drugs for common immediate basis store and Netmeds.com diseases can be evaluated as due to lack of have been helping them in the future of pharma pharmaceutical getting the medicines on an industries. shops. immediate basis. These applications operate on both Android and windows version and are open for 24*7.

(Source: Pwc.com, 2018)

APPENDIX 2: SWOT Analysis Table

Company Strengths Weaknesses Opportunities Threats

Bell Canada ● Wide ● Stiff ● Strategic ● Rising distributio competition acquisition competition n network ● Dependenc globally from new ● Popular e on ● Investment players branding subsidiaries in 5G ● Government ● Good ● Bad technology policies that advertisem reputation are ever ents due to changing censorship, ● Regulatory and obligation misleading prices

Rogers ● Diverse ● Has a ● As a way to ● Stiff Communica business limited capture the competition tions Inc operations global market, they ● High from presence can launch customer Media, to and limited the first ever pressure sports and customer WIFI smart from telecommu base phone customers nication ● Mostly service from Bell ● Large depends on ● Increased and Telco customer the growth of ● Rapid base Canadian Telecommu changes in ● Strong Market nication in technology brand Canada. ● Strategic business initiatives that enhance diversificat ion, and consumpti on of products by customers .

Telus ● Efficient ● Declined ● The ● High Corporation operations performanc expected competition ● Market e of growth of ● Regulatory leadership wireless telecommun policies in Canada network ications ● Changing ● Large ● Limited industry government customer global ● Investment policies base presence in new 5G ● Strong technology brand and IoMT image ● Next generation telecommu nication infrastruct ure ● Diverse business endeavors

APPENDIX 3 – VRIO FRAMEWORK

Bell Canada

Supply Chain Operations Distribution Sales/Marketing Service

Value: Value: Value: Value: Value: Depends on third Gives It is the largest Has made Installed the use party suppliers comprehensive communication investments in of online service Reduced It services on company in areas such as or self-service network supply residential, Canada sports and in TV capabilities chains due to business, and Provides services therefore creating which diversified renegotiated wholesale both online and a large following its usability and contracts with customers in in stores attracted more key IT players wireline voice customers and wireless communication

Rarity: NO Rarity: NO Rarity: NO Rarity: NO Rarity: NO The services Other rivals The rivals of the Bell Corporation The services provided by Bell provide the same company also uses various provided by Bell are also the same services with the use similar marketing such as mobile in its rivals such same operations distribution channels such as and fixed line Telus and Rogers channels. The digital and social services, internet rivals also media platforms. services etc. are distribute their These channels also provided by products in are also used by the rivals of this similar areas. the rivals. company.

Imitable: YES Imitable: YES Imitable: YES Imitable: YES Imitable: YES The supply chain The services The distribution The marketing The services of of Bell is based provided by this channels can channels are also Bell Corporation on third party. company can be also be easily easily available to are imitable as This can be easily provided imitated by the the rivals. Hence, the services are easily followed by its rivals as rivals. This is due this can be very basic in this by the rivals. these are the to the fact that imitable. industry. The basic services the distribution rivals can easily that are provided channels are imitate the by telecom common among services provided companies. the telecom by Bell. companies.

Organization Organization Organization Organization Organization The highly Bell Corporation The distribution High investment The efficient structured can easily reap channels can be of this company management and organization can the benefit of improved by the in marketing will organizational grab the benefit high demand and organization in help in increasing structure, Bell of third party can supply the order to attract its client base can improve its supply chain services as per greater number and market services in order the preferences of consumers. share. to increase of the customers. customer satisfaction.

(Source: Goodwin, 2012)

TELUS

Skill/Resour Valuable Rare Non-imitable Organizationally ce/capability exploited

HR: YES NO NO YES Employee The leadership The training The training Telco has a training and programs are programs are very programs can be structure Leadership helpful in common among easily imitated by organization due to programs increasing the rivals as well. the other which the company organizational companies as would be able efficiency. these are basic exploit the training features of any programs and business improve organization, organizational efficiency profitably.

Marketing: YES NO NO YES Friendly Strong brand The marketing The marketing On the other hand, work image of the strategies of this strategies can be Telco can capture environment company can be company are also easily imitated by higher market share Knowledgea marketed common among the rivals. with the use of ble staff effectively. This the rivals. The effective marketing Strong would increase competitors are strategies. brand brand awareness also aimed at as well as brand increasing their loyalty. brand loyalty and client base.

R&D: YES NO NO YES Innovation The company The rivals of The innovative On the contrary, and problem invests Telco also activities of Telco Telco will be able to solving significant conduct can also be easily capture the market amount on innovative adopted and demand by research and activities in order imitated by the undertaking to increase rivals. innovative services.

development customer activities. attraction.

Operations: YES NO NO YES Network Telco provides Wide network The operational High quality coverage wide coverage of coverage and services of Telco operational services and reliable network, the reliability is also are also easily of Telco would be connectivity connectivity is present in the imitable by the helpful in capturing also reliable. This operational rivals. the high market helps in attracting services of the demand. wide number of rivals. customers.

Procurement YES NO NO YES : Telco has made However, Procurement of The strategic Strategic strategic alliances strategic alliance Telco is easily alliance of Telco alliances due to which it can also be imitable by the would help in has been able to undertaken by the rivals. exploiting the capture larger rivals of this market market share. company as well. opportunities due to which the company would be able to increase its profitability.

Service: YES NO NO YES Post sale The post sale The post sale The post sale The organization support support services service is also service can be would be able to of Telco are common among easily imitated as it exploit this valuable valuable. It has the competitors. is also considered post sale service in also helped in as basic order to grab market increasing requirements of the opportunities. customer clients. satisfaction.

(Source: Hartlen, 2015)

Rogers Communication Inc

Competitive Performance Valuable Rare Costly to Non consequence implications imitate substitutable

Competitive advantage Below average No No No No returns

Competitive parity Average returns Yes No No Yes

Temporary competitive Average or above Yes Yes No Yes advantage returns

Sustainable Above average Yes Yes Yes Yes competitive advantage returns

(Source: Bisson, 2013)

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